Title : Barriers to early initiation of breastfeeding and the role of human milk banking in improving neonatal outcomes: Experience from Maharashtra, India

Background: Early initiation of breastfeeding (EIBF) within one hour of birth is a proven intervention for reducing neonatal morbidity and mortality. Despite high institutional delivery rates in India, timely breastfeeding initiation remains suboptimal. Human Milk Banks (HMBs) provide donor human milk to vulnerable neonates when mother’s own milk is unavailable.

Objectives: To identify barriers to EIBF, evaluate the contribution of Human Milk Banks and innovative milk collection strategies, and propose interventions to improve breastfeeding practices.

Methods: A descriptive review was conducted using experiences from government medical colleges, human milk banking programs, and community-based breastfeeding initiatives in Maharashtra. Institutional, maternal, health-system, and socio-cultural barriers were analyzed.

Results: Key barriers included overcrowded labor rooms, shortage of trained lactation counselors, inadequate staffing, cesarean deliveries, low maternal awareness, documentation burden, early discharge practices, and misconceptions regarding breastfeeding. Human Milk Banks and India’s first Mobile Human Milk Collection Unit improved donor participation, milk collection, and support for preterm, low-birth-weight, orphaned, and abandoned newborns.

Conclusion: Strengthening Human Milk Banks, lactation counseling services, community outreach, and policy support can improve breastfeeding practices, neonatal nutrition, and newborn survival outcomes.

Dr. Sandhya Satish Khadse, MBBS, MD, is a senior pediatrician and Dean with over 37 years of experience in pediatrics, neonatal health, public health, and medical education. She has published more than 40 scientific papers and pioneered India's first Human Milk Collection Van, an innovative initiative supporting breastfeeding and neonatal nutrition. She has mentored numerous postgraduate students, led maternal and child health programs, and received several national awards for excellence in healthcare leadership and breastfeeding promotion.